Venous Tumor Thrombus in Primary Bone Sarcomas in the Pelvis

Abstract

Background:Few investigations of venous tumor thrombus (VTT) in primary pelvic bone sarcomas are available. We aimed to identify the prevalence, associated factors, and prognosis of VTT across different types of pelvic sarcomas and to propose an algorithm for management.Methods:We included 451 consecutive cases of primary, bone-derived, treatment-naive, pelvic sarcomas in this study. Demographic data and the results of initial laboratory tests, imaging examinations, and oncological evaluations were extracted and analyzed. Forty-four cases of VTT were diagnosed with radiographic examinations, and 18 of them were verified histologically.Results:The cohort consisted of chondrosarcomas (41.2%), osteosarcomas (30.4%), Ewing sarcomas (15.5%), bone-derived undifferentiated pleomorphic sarcomas (5.8%), and other bone sarcomas (7.1%). The prevalence of VTT was 9.8% in the whole group, and associated factors included a lactate dehydrogenase (LDH) level of ≥230.5 U/L and invasion of the L5-S1 intervertebral foramen. Patients with pelvic osteosarcoma had a high prevalence of VTT (22.6%), and the associated factors in this group included a chondroblastic subtype, an LDH level of ≥187 U/L, and invasion of the obturator foramen and the L5-S1 intervertebral foramen. Patients with VTT had a poor prognosis with a median overall survival time of 14 months. Subgroup analyses of localized pelvic osteosarcoma indicated that the presence of VTT decreased the median overall survival time (21.5 versus 54.0 months for those without VTT, p = 0.003), median recurrence-free survival time (18.6 versus 32.4 months, p = 0.020), and median metastasis-free survival time (11.2 versus 41.0 months, p < 0.001).Conclusions:VTT is most common in patients with pelvic osteosarcoma as compared with patients with other primary bone sarcomas, and it is associated with several factors. It is a negative prognostic factor. An algorithm for management of pelvic sarcomas with VTT stratified by the classification of the VTT might be beneficial, but further validation is necessary.Level of Evidence:Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

The management of sacral tumours

“…While poorly quantified, the available clinical data suggest that this phenomenon carries a poor prognosis for the patient. 23…”

What’s New in Musculoskeletal Tumor Surgery

“…A few studies have identified risk factors for poorer oncologic and surgical outcomes in pelvic tumors. These include a venous tumor thrombus, a margin of <2 mm, complete acetabular resection compared with transacetabular resection, and sarcopenia 1,3,7,8 .…”

“…A few studies have identified risk factors for poorer oncologic and surgical outcomes in pelvic tumors. These include a venous tumor thrombus, a margin of <2 mm, complete acetabular resection compared with transacetabular resection, and sarcopenia 1,3,7,8 .The National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database, the American College of Surgeons (ACS) National Cancer Database, and the California Cancer Registry were queried by several authors who concluded that radiation therapy is the most common local modality used in the United States for Ewing sarcoma of the sacrum or pelvis and has similar efficacy to surgical resection with or without radiation therapy; that 5-year disease-specific survival in patients with mobile vertebral column sarcomas was 56%, with worse survival for osteosarcoma; and that patients with malignancies of the mobile spine with public insurance are vulnerable to worse outcomes, even if they receive standard treatment 6,9,11 .Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/H270).…”

Integrated analysis of single-cell and bulk RNA sequencing data reveals an immunostimulatory microenvironment in tumor thrombus of osteosarcoma

“…However, nearly 20% of OS patients are found to have metastasis at diagnosis, with a poor prognosis due to insensitivity to standard therapy [ 2 , 5 , 6 ]. One aggressive characteristic of primary OS is its tendency to intravasate into the adjacent veins and generate a metastatic tumor thrombus (almost 23% patients of with primary pelvic OS were found to have tumor thrombus), which could be exploited as a special study model for the early stage of tumor metastasis [ 7 ]. The occurrence of tumor thrombus substantially increases the rate of metastasis in many tumor types including osteosarcoma, renal cell carcinoma, and hepatocellular carcinoma [ 7 – 9 ].…”

“…One aggressive characteristic of primary OS is its tendency to intravasate into the adjacent veins and generate a metastatic tumor thrombus (almost 23% patients of with primary pelvic OS were found to have tumor thrombus), which could be exploited as a special study model for the early stage of tumor metastasis [ 7 ]. The occurrence of tumor thrombus substantially increases the rate of metastasis in many tumor types including osteosarcoma, renal cell carcinoma, and hepatocellular carcinoma [ 7 – 9 ]. Patients with tumor thrombus in OS generally had a worse prognosis due to early distant metastasis and high local recurrence risk since scraps of tumor thrombus could skip across the reactive zone encapsulating the tumor and metastasize to distant organs early in the disease process [ 7 ].…”